The Wall Street Journal reported in April that the Justice Department would conduct a “criminal investigation into consulting firm McKinsey related to its past role in advising some of the nation’s largest opioid manufacturers on how to boost sales.”
According to the WSJ report, “McKinsey consultants advised the company [Purdue] on how to increase sales of its flagship drug, including suggesting that Purdue’s sales team make more calls to healthcare providers it knew wrote high volumes of OxyContin prescriptions and spend less time on doctors who prescribed the opioid medication the least, the records showed.” Oxy
Imagine that. McKinsey allegedly tried to help Purdue tailor its sales efforts to doctors who already prescribed oral opioid drugs. There’s nothing mysterious or nefarious about this. It is standard and economically rational. To do otherwise would be inefficient and wasteful. Some consultants do this sort of work virtually every day. The small consulting company, Objective Insights, Inc. (co-owned by one of the authors) has performed it a handful of times.
This is from David R. Henderson and Charles L. Hooper, “Is Promoting to Customers a Crime?” American Institute for Economic Research, June 18, 2024.
Read the whole thing, which is not long.
READER COMMENTS
Richard W Fulmer
Jun 18 2024 at 8:28pm
If this goes to SCOTUS, it will be shot down on First Amendment grounds – probably unanimously.
Komori
Jun 19 2024 at 4:54pm
It hardly matters any more. The federal government is increasingly in “the process is the punishment” mode. That’s not likely to change unless prosecutorial immunity gets limited.
“To my friends, everything; to my enemies, the law.”
— Oscar Benavides
Richard W Fulmer
Jun 20 2024 at 11:45am
Good point. The fear of having to (even successfully) deal with a DoJ investigation and possible criminal prosecution would be enough to deter many, if not most, companies and individuals from any activities that might draw DoJ attention.
Craig
Jun 19 2024 at 10:09am
The good is legal but it is obviously a controlled substance. While I agree with the libertarians that it shouldn’t be, that it should at minimum be decriminalized if not legalized entirely or perhaps left to the states, the fact is at the moment is that it isn’t.
“more calls to healthcare providers it knew wrote high volumes of OxyContin prescriptions”
Or, in other words, to focus on healthcare providers that they knew or should have known were ‘overprescribing’ the product. That’s a rabbit hole unto itself of course.
https://www.justice.gov/opa/pr/pain-clinic-owner-sentenced-role-operating-pill-mills-tennessee-and-florida
““This defendant reaped millions of dollars in personal profits by operating destructive opioid pill mills in multiple states, inflicting lasting harm on multiple communities,” said Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division. ”
So if McKinsey is telling Purdue to focus on these practitioners their advice is effectively to market to practitioners they knew were violating the law. And yeah, they knew, I mean, don’t get me wrong, maybe that can’t be proven in court, but its perhaps akin to motel owners being complicit in prostitution when they rent rooms out by the hour.
Charley Hooper
Jun 19 2024 at 12:57pm
Please see below.
steve
Jun 19 2024 at 10:55am
If McKinsey didnt know or didnt have reason to suspect, that they were advising Purdue to sell even more drugs to doctors that were already handing out narcs illegally, then they should be found innocent. Since it sounds like they had access to sales records I find it hard to believe that they did not know.
“McKinsey allegedly tried to help Purdue tailor its sales efforts to doctors who already prescribed oral opioid drugs. There’s nothing mysterious or nefarious about this.”
This is incorrect. As reported in the prior paragraph they were “suggesting that Purdue’s sales team make more calls to healthcare providers it knew wrote high volumes of OxyContin prescriptions and spend less time on doctors who prescribed the opioid medication the least.” If they had advised methods to increase sales by docs who weren’t ordering fewer pills I think they would have had a better case.
They were deliberately choosing high volume people and staying away from low volume people. It was well known that there were pill mills handing out drugs illegally and McKinsey appears to suggest increasing sales to those people.
(To be clear on this, I founded the pain service at my network, a multi-specialty team offering many approaches to treating pain, including narcotics. In the process of getting educated on the issues I talked with people about the amount of narcotics the pill mill people were ordering vs my pain guys who were ordering lots of narcotics. People develop tolerance pretty quickly so my guys are sometimes ordering massive amounts of drugs for end stage cancer patients. Anyway, the pill mills were ordering way more than my guys. It’s not just that they were ordering more, but that they were ordering more by a large margin.)
The other issue was the marketing around Oxy, the claims that it did not lead to addiction. Besides the pill mills the other target would have been docs ordering more Oxy because they actually believed the sales pitch. The drug companies knew pretty early that their advertising was false. There may be a valid question depending upon the date of McKinsey’s consultation on whether this was widely known yet.
Query- Selling guns is legal. Would Objective Insights advise increasing gun sales to groups that they knew were using them to kill people during criminal activities?
Steve
Charley Hooper
Jun 19 2024 at 12:58pm
Please see below.
Charley Hooper
Jun 19 2024 at 2:01pm
Do you have a source/link for this? Thanks.
steve
Jun 19 2024 at 4:42pm
https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxycontin.html
Purdue knew well before 2000 that Oxy was being abused. Given that they were selling millions of pills in small, isolated towns it’s hard to believe they didnt know the drug was being diverted and abused. Yet they kept marketing its as a drug that couldn’t/wouldnt be abused. Of note, they also mislead people on the potency of the drug so that they thought it was a milder narcotic so better used as a first line drug.
Steve
Charley Hooper
Jun 19 2024 at 12:57pm
Craig and steve, your arguments rest on three assumptions.
1: We accept the definition of “overprescribing.” The term is often used by law enforcement agencies looking to punish offenders. For us to accept that overprescribing was happening, we would need to have more information about each patient’s case. Because of fears of law enforcement actions, there are many, many patients with legitimate pain who aren’t getting the painkillers they want/need.
2: McKinsey and/or Purdue knew that some of their customers were breaking the law and they kept making sales calls. Did McKinsey and Purdue have enough information and the skills necessary to determine if laws were being broken? And, if so, do we know that McKinsey and Purdue kept making sales calls to these customers? Or did they stop?
3: We wouldn’t even be having this discussion were it not for the assumption that prescription opioids are especially dangerous.
Among patients who honestly want pain relief, problems are uncommon.
Studies show that, among patients who seek pain relief, prescription opioids are very unlikely to lead to abuse and addiction. Prescription opioids are regularly diverted to others who do want to get high and the opioid abuse epidemic didn’t take off until an abuse-resistant version of OxyContin was released in August 2010. Not able to get high on diverted Rx opioids, people turned to heroin and fentanyl with questionable purity and the real problems started.
steve
Jun 19 2024 at 4:30pm
That’s not how you catch overprescribes. You look at their pt population, what kind of practice they have, their specialty and the number of prescriptions they hand out compared to similar practitioners. Some of my pain docs are writing prescriptions for huge amounts of drugs, but they are trained pain docs and they are treating pts for whom you would expect large numbers and their numbers are in line with what other pain docs are ordering.
As to patients being undertreated now due to fears of prescribing narcotics I think there is some truth to that, though as I keep pointing out my pain docs are ordering large amounts of narcotics for some patients and its not causing any issues. What we saw was that with Oxy due to the marketing people overprescribed the drug. It was easy to do, you didnt need much expertise and it worked well in the short run. However, for many patients they arent the right choice. Care should be individualized and you shouldn’t be handing out large amounts of pills just because its easier and the pretty blonde rep shows you literature from the drug maker claiming its safe and effective. (BTW, I also think docs bear a lot fo responsibility.)
steve
Jun 19 2024 at 4:45pm
That’s not how you catch overprescribes. You look at their pt population, what kind of practice they have, their specialty and the number of prescriptions they hand out compared to similar practitioners. Some of my pain docs are writing prescriptions for huge amounts of drugs, but they are trained pain docs and they are treating pts for whom you would expect large numbers and their numbers are in line with what other pain docs are ordering.
As to patients being undertreated now due to fears of prescribing narcotics I think there is some truth to that, though as I keep pointing out my pain docs are ordering large amounts of narcotics for some patients and its not causing any issues. What we saw was that with Oxy due to the marketing people overprescribed the drug. It was easy to do, you didnt need much expertise and it worked well in the short run. However, for many patients they arent the right choice. Care should be individualized and you shouldn’t be handing out large amounts of pills just because its easier and the pretty blonde rep shows you literature from the drug maker claiming its safe and effective. (BTW, I also think docs bear a lot fo responsibility.)
2. They certainly had enough knowledge to be suspicious. Link goes go the case where drug companies sent over 20 million narcotic pills to a town of 3000 in West Virginia, a town not close to any major city. That was not the only small town where similar happened. From memory, which could be wrong, I think that small town in the middle of nowhere was handling about 15%-20% of the state’s narcotic pills. That was a huge red flag.
3) They promoted Oxy as having much less risk of addiction than other narcotics. When used appropriately the risk is small but real. However, many docs believed the sales reps and they ordered lots of pills, using them when it really wasn’t the best treatment but they thought it was safe. It’s a lot easier to just hand out Oxy than it is to try to convince someone to go to physical therapy. Also, the abuse resistant drugs have a number of papers reporting that there seems to be a ceiling so many people continued to abuse them rather than change to heroin et al.
https://www.npr.org/sections/thetwo-way/2018/01/30/581930051/drug-distributors-shipped-20-8-million-painkillers-to-west-virginia-town-of-3-00
Steve
Charley Hooper
Jun 19 2024 at 9:04pm
For the record, if there’s a wholesaler, distributor, or warehouse in that small town, one would expect large volumes of product to be shipped there.
I think we’re agreeing: it’s hard to spot overprescribing without knowing something about the practice and the patients. To push this detective and enforcement responsibility on the drug company seems to me to be too much.
Also for the record, the FDA is very strict about pharmaceutical promotional activities. Drug companies are allowed to promote only what is in the drug’s label (prescribing information). So I don’t know if the promotion you’re mentioning went beyond the label or not. If it was consistent with the label, then blame the FDA not the drug company. If it was beyond the label, the full force of the FDA was probably brought down on the drug company.
steve
Jun 20 2024 at 9:36am
The FDA has no idea what drug reps are telling people. Also, while Purdue knew before 2000 that people were abusing the drug they had advertised as being resistant to abuse it wasn’t widely known for a while so the FDA had no reason to clamp down on that advertising for quite a while.
Steve
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